Maturitas 81 (2015) 487–492
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Moderate-severely bothersome vasomotor symptoms are associated with lowered psychological general wellbeing in women at midlife Pragya Gartoulla, Robin J. Bell, Roisin Worsley, Susan R. Davis ∗ Women’s Health Research Program Department of Epidemiology and Preventive Medicine Monash University, Level 6, The Alfred Centre 99, Commercial Road, Melbourne 3004 Victoria, Australia
a r t i c l e
i n f o
Article history: Received 25 May 2015 Received in revised form 3 June 2015 Accepted 4 June 2015 Keywords: Vasomotor symptoms Psychological general wellbeing Menopause
a b s t r a c t Objectives: The extent to which menopause influences wellbeing is unclear. We investigated the association between moderate-severely bothersome vasomotor symptoms (VMS) and psychological general wellbeing in women, aged 40–65 years, taking into account socio-demographic and lifestyle factors. Study design/Main outcome measures: This was a cross-sectional survey of 2020 Australian women, aged 40–65 years, recruited from the community between July 2013 and March 2014. Wellbeing was assessed by the Psychological and General Wellbeing questionnaire (PGWB) and VMS by the Menopause-specific Quality of Life Questionnaire. Results: Moderate-severely bothersome VMS had a strong significant negative association with psychological general wellbeing [regression coefficient (ˇ) = −8.17, 95% confidence interval (CI) −10.90 to −5.45]. Socio-demographic factors associated with lower wellbeing included being un-partnered (ˇ = −2.80, 95% CI −4.74 to −0.86), obese (ˇ = −5.46, 95% CI −7.24 to −3.68) and a smoker (ˇ = −3.47, 95% CI −6.10 to −0.84). Older age (ˇ = 0.29, 95% CI 0.06–0.42) and participation in paid and/or volunteer work (ˇ = 2.72, 95% CI 0.61–4.82) were positively associated with wellbeing. For those with insecure housing, being a carer was associated with better wellbeing. Conclusions: Moderate-severely bothersome VMS are significantly and independently negatively associated with psychological general wellbeing in women at midlife. This is an important consideration when assessing psychological wellbeing in women during this life phase. © 2015 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Menopause is the loss of ovarian reproductive function resulting in the loss of cyclical estrogen, progesterone and androgen production by the ovaries. This change is characterized by symptoms of estrogen deficiency and, in non-hysterectomized women, permanent cessation of menstrual cycles. The age of natural menopause varies globally and is between 47 and 52 years [1]. Earlier menopause may be iatrogenic, as in the case of surgical menopause or following chemotherapy, or due to a range of conditions that cause premature ovarian insufficiency [1]. The cardinal symptoms of menopausal estrogen deficiency include vasomotor symptoms (VMS; hot flushes and night sweats), joint pain, urogenital atrophy, fragmented sleep and lowered mood [1]. The median duration of VMS is 4.5 years from the final menstrual period, although women with an earlier onset of VMS have an average symptom duration of over 10 years [2].
∗ Corresponding author. Tel.: +61 3 9903 0827. E-mail address: [email protected] (S.R. Davis). http://dx.doi.org/10.1016/j.maturitas.2015.06.004 0378-5122/© 2015 Elsevier Ireland Ltd. All rights reserved.
Over 74% of postmenopausal Australian women younger than 55 years experience VMS and 25% of women aged 40–65 years who experience VMS describe them as moderately to severely bothersome [3]. A large multinational study concluded that VMS adversely affected quality of life. The latter was assessed by the Menopause Rating Scale, which is not a validated quality of life measure [4]. Other studies of VMS and psychological wellbeing either have not assessed VMS by validated instruments, have not taken into account VMS severity, or have used an overall assessment of menopause as opposed to VMS [4–7]. Therefore, the degree to which VMS influence wellbeing remains uncertain. Wellbeing, which comprises both the presence of positive affect and lack of symptoms of distress, is generally considered to be relatively stable in individuals across the life span [8]. Nonetheless, older age and higher socio-economic status have been independently associated with better psychological general wellbeing; whereas smoking, obesity, being a carer for another person and having insecure housing have been associated with poorer wellbeing [9–13]. Hence socio-demographic and life style factors must be taken into account when evaluating wellbeing.
488
P. Gartoulla et al. / Maturitas 81 (2015) 487–492
The aim of the present study was to investigate the association between moderate to severe VMS and psychological general wellbeing in Australian women, aged 40–65 years, taking into account factors that have been previously reported to impact wellbeing in women of this age. The validated instruments used in our study enabled us to measure the presence and severity of VMS as well as self-reported psychological general wellbeing.
summed to provide a total score. The answers to some questions are reverse-scored so that a higher score represents better wellbeing for the total score (range 0–110) and the individual domains. The PGWB has been shown to demonstrate validity and reliability. Data from its use in the National Health and Nutrition Examination Survey have demonstrated that it can be generalized to non-institutionalized adults aged 25–74 years [17].
2. Method
2.4. Sample size
2.1. Participants
The study sample size of 2000 was based on the primary outcome of the study, moderate to severe VMS, with 95% confidence interval of ±2% around a percentage prevalence estimate of 30% [18]. We purposefully sampled women so that the age distribution of our sample mimicked the age distribution of the adult Australian female population in the age range 40–65 years in 2011[19].
Study participants were recruited between July 2013 and March 2014 from a database derived from the Australian electoral roll (the Roy Morgan Research Single Source Database). All people in this database are contactable by telephone. The details of the recruitment have been published [3]. In brief, women in the database, aged between 40 and 65 years, were randomly contacted by telephone and invited to participate in a ‘survey of the health of women at midlife’. We only excluded women unable to complete a questionnaire in English. The women who verbally agreed to participate were sent a study questionnaire and a reply paid envelope. Completion of a questionnaire was accepted as written informed consent. We asked participants to consent to re-contact by phone for essential data clarification and a free-call telephone number was provided for those needing assistance with the questionnaire. All questionnaires were checked for completeness and de-identified questionnaires were electronically scanned and incorporated into an SPSS database. 2.2. Assessment of menopausal status and menopausal symptoms Women were classified as premenopausal, perimenopausal or postmenopausal using published algorithms [14] derived from the Stages of Reproductive Ageing Workshop (STRAW) +10 criteria [15]. Age, history of bilateral oophorectomy, menstrual bleeding pattern, reporting of VMS as well as hysterectomy and use of systemic hormones (contraception or menopausal hormone therapy, MHT) were used to classify women. Postmenopausal women were further classified as aged 5–8). Therefore, the overall VMS domain score was categorised as none/mild (score ≥1 to ≤5) and moderate-severely bothersome (score >5–8) for the analysis. 2.3. Assessment of wellbeing Wellbeing was assessed using the Psychological General Wellbeing Index (PGWB) [17], a validated 22-item questionnaire. The domains for the PGWB are anxiety, depressed mood, positive wellbeing, self-control, general health and vitality, and these are
2.5. Statistical analysis Socio-demographic characteristics included age, relationship status, education, residential location (metro/non-metro), working status, number of children and being a carer for a family member with special needs. Housing financial security was assessed by asking women if they were confident about continuing to afford to live in their current accommodation. Other lifestyle factors included current smoking, current alcohol consumption and body mass index (BMI) derived from self-reported height and weight. BMI was divided into three categories:
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Moderate-severely bothersome vasomotor symptoms are associated with lowered psychological general wellbeing in women at midlife Pragya Gartoulla, Robin J. Bell, Roisin Worsley, Susan R. Davis ∗ Women’s Health Research Program Department of Epidemiology and Preventive Medicine Monash University, Level 6, The Alfred Centre 99, Commercial Road, Melbourne 3004 Victoria, Australia
a r t i c l e
i n f o
Article history: Received 25 May 2015 Received in revised form 3 June 2015 Accepted 4 June 2015 Keywords: Vasomotor symptoms Psychological general wellbeing Menopause
a b s t r a c t Objectives: The extent to which menopause influences wellbeing is unclear. We investigated the association between moderate-severely bothersome vasomotor symptoms (VMS) and psychological general wellbeing in women, aged 40–65 years, taking into account socio-demographic and lifestyle factors. Study design/Main outcome measures: This was a cross-sectional survey of 2020 Australian women, aged 40–65 years, recruited from the community between July 2013 and March 2014. Wellbeing was assessed by the Psychological and General Wellbeing questionnaire (PGWB) and VMS by the Menopause-specific Quality of Life Questionnaire. Results: Moderate-severely bothersome VMS had a strong significant negative association with psychological general wellbeing [regression coefficient (ˇ) = −8.17, 95% confidence interval (CI) −10.90 to −5.45]. Socio-demographic factors associated with lower wellbeing included being un-partnered (ˇ = −2.80, 95% CI −4.74 to −0.86), obese (ˇ = −5.46, 95% CI −7.24 to −3.68) and a smoker (ˇ = −3.47, 95% CI −6.10 to −0.84). Older age (ˇ = 0.29, 95% CI 0.06–0.42) and participation in paid and/or volunteer work (ˇ = 2.72, 95% CI 0.61–4.82) were positively associated with wellbeing. For those with insecure housing, being a carer was associated with better wellbeing. Conclusions: Moderate-severely bothersome VMS are significantly and independently negatively associated with psychological general wellbeing in women at midlife. This is an important consideration when assessing psychological wellbeing in women during this life phase. © 2015 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Menopause is the loss of ovarian reproductive function resulting in the loss of cyclical estrogen, progesterone and androgen production by the ovaries. This change is characterized by symptoms of estrogen deficiency and, in non-hysterectomized women, permanent cessation of menstrual cycles. The age of natural menopause varies globally and is between 47 and 52 years [1]. Earlier menopause may be iatrogenic, as in the case of surgical menopause or following chemotherapy, or due to a range of conditions that cause premature ovarian insufficiency [1]. The cardinal symptoms of menopausal estrogen deficiency include vasomotor symptoms (VMS; hot flushes and night sweats), joint pain, urogenital atrophy, fragmented sleep and lowered mood [1]. The median duration of VMS is 4.5 years from the final menstrual period, although women with an earlier onset of VMS have an average symptom duration of over 10 years [2].
∗ Corresponding author. Tel.: +61 3 9903 0827. E-mail address: [email protected] (S.R. Davis). http://dx.doi.org/10.1016/j.maturitas.2015.06.004 0378-5122/© 2015 Elsevier Ireland Ltd. All rights reserved.
Over 74% of postmenopausal Australian women younger than 55 years experience VMS and 25% of women aged 40–65 years who experience VMS describe them as moderately to severely bothersome [3]. A large multinational study concluded that VMS adversely affected quality of life. The latter was assessed by the Menopause Rating Scale, which is not a validated quality of life measure [4]. Other studies of VMS and psychological wellbeing either have not assessed VMS by validated instruments, have not taken into account VMS severity, or have used an overall assessment of menopause as opposed to VMS [4–7]. Therefore, the degree to which VMS influence wellbeing remains uncertain. Wellbeing, which comprises both the presence of positive affect and lack of symptoms of distress, is generally considered to be relatively stable in individuals across the life span [8]. Nonetheless, older age and higher socio-economic status have been independently associated with better psychological general wellbeing; whereas smoking, obesity, being a carer for another person and having insecure housing have been associated with poorer wellbeing [9–13]. Hence socio-demographic and life style factors must be taken into account when evaluating wellbeing.
488
P. Gartoulla et al. / Maturitas 81 (2015) 487–492
The aim of the present study was to investigate the association between moderate to severe VMS and psychological general wellbeing in Australian women, aged 40–65 years, taking into account factors that have been previously reported to impact wellbeing in women of this age. The validated instruments used in our study enabled us to measure the presence and severity of VMS as well as self-reported psychological general wellbeing.
summed to provide a total score. The answers to some questions are reverse-scored so that a higher score represents better wellbeing for the total score (range 0–110) and the individual domains. The PGWB has been shown to demonstrate validity and reliability. Data from its use in the National Health and Nutrition Examination Survey have demonstrated that it can be generalized to non-institutionalized adults aged 25–74 years [17].
2. Method
2.4. Sample size
2.1. Participants
The study sample size of 2000 was based on the primary outcome of the study, moderate to severe VMS, with 95% confidence interval of ±2% around a percentage prevalence estimate of 30% [18]. We purposefully sampled women so that the age distribution of our sample mimicked the age distribution of the adult Australian female population in the age range 40–65 years in 2011[19].
Study participants were recruited between July 2013 and March 2014 from a database derived from the Australian electoral roll (the Roy Morgan Research Single Source Database). All people in this database are contactable by telephone. The details of the recruitment have been published [3]. In brief, women in the database, aged between 40 and 65 years, were randomly contacted by telephone and invited to participate in a ‘survey of the health of women at midlife’. We only excluded women unable to complete a questionnaire in English. The women who verbally agreed to participate were sent a study questionnaire and a reply paid envelope. Completion of a questionnaire was accepted as written informed consent. We asked participants to consent to re-contact by phone for essential data clarification and a free-call telephone number was provided for those needing assistance with the questionnaire. All questionnaires were checked for completeness and de-identified questionnaires were electronically scanned and incorporated into an SPSS database. 2.2. Assessment of menopausal status and menopausal symptoms Women were classified as premenopausal, perimenopausal or postmenopausal using published algorithms [14] derived from the Stages of Reproductive Ageing Workshop (STRAW) +10 criteria [15]. Age, history of bilateral oophorectomy, menstrual bleeding pattern, reporting of VMS as well as hysterectomy and use of systemic hormones (contraception or menopausal hormone therapy, MHT) were used to classify women. Postmenopausal women were further classified as aged 5–8). Therefore, the overall VMS domain score was categorised as none/mild (score ≥1 to ≤5) and moderate-severely bothersome (score >5–8) for the analysis. 2.3. Assessment of wellbeing Wellbeing was assessed using the Psychological General Wellbeing Index (PGWB) [17], a validated 22-item questionnaire. The domains for the PGWB are anxiety, depressed mood, positive wellbeing, self-control, general health and vitality, and these are
2.5. Statistical analysis Socio-demographic characteristics included age, relationship status, education, residential location (metro/non-metro), working status, number of children and being a carer for a family member with special needs. Housing financial security was assessed by asking women if they were confident about continuing to afford to live in their current accommodation. Other lifestyle factors included current smoking, current alcohol consumption and body mass index (BMI) derived from self-reported height and weight. BMI was divided into three categories:
